New York's 2026 Nursing Home Incident Reporting Manual: What Is Reportable Now

On August 24, 2026, the New York State Department of Health issued DAL DRS 26-05, transmitting Version 2026-2 of the Nursing Home Incident Reporting Manual. The cover letter includes a number worth reading twice: since October 1, 2025, surveyors have "cited 96 Nursing Homes over 100 times related to incident reports." That is the Department telling you where it is finding deficiencies.

Initial coverage has summarized the release. This is the practical piece: what the manual says is reportable, the fall scenarios, how the New York layer sits on the federal rule, and the timing question that decides many determinations.

One scope note. This article describes the published rules. The administrator makes the reporting decision for a specific incident, and facility counsel and the regional office answer the edge cases.

Which Version This Article Quotes

The quotations from the manual in this article are from its 2026 text as verified against the July 2026 edition, Version 2026-1: the category headings in Section 2, the immediate-telephone events in Section 1, the scenario questions and answers, and the timing language. DAL DRS 26-05 transmitted Version 2026-2. Facilities should work from the version linked in the DAL.

The reporting mechanism dates to DAL NH 22-20 (October 18, 2022), which announced that effective October 24, 2022, "The new Facility Incident Reporting Form will replace the previous method of reporting using the Health Commerce System (HCS)." That DAL listed the reportable incidents as "Abuse, neglect, mistreatment and exploitation; Misappropriation; Injury of unknown origin; Physical environment incidents (ex. fire, loss of services); Elopement; Death not due to natural causes."

The initial report form is public. It does not require an HCS login, which matters at 2 a.m. when the reporter is a supervisor without HCS credentials. One quirk: the form warns that "An incident report cannot be saved and completed later." Gather what you have and submit in one sitting. You are expected to report, not to have finished the investigation.

The 5-day follow-up is a separate online form, the Nursing Home Investigative Report, which the form itself says is due "Within five (5) business days of the incident." Questions on either form go to the Bureau of Intake Management at nhFRI@health.ny.gov.

The Federal Floor: What 42 CFR 483.12 Requires

Every determination begins at the federal floor. 42 CFR 483.12(c)(1) requires that alleged violations "involving abuse, neglect, exploitation or mistreatment, including injuries of unknown source and misappropriation of resident property, are reported immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury, or not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury, to the administrator of the facility and to other officials (including to the State Survey Agency and adult protective services where state law provides for jurisdiction in long-term care facilities)". Under 483.12(c)(4), the results of the investigation are reported "within 5 working days of the incident."

Surveyors cite these failures under F609 (the F-tag reference covers the full family). For fall determinations, the definition of injury of unknown source matters most. Appendix PP requires all three: "The source of the injury was not observed by any person; and The source of the injury could not be explained by the resident; and The injury is suspicious because of the extent of the injury or the location of the injury (e.g., the injury is located in an area not generally vulnerable to trauma) or the number of injuries observed at one particular point in time or the incidence of injuries over time."

Serious bodily injury, which drives the 2-hour window, is defined in Section 2011(19) of the Social Security Act: an injury "(i) involving extreme physical pain; (ii) involving substantial risk of death; (iii) involving protracted loss or impairment of the function of a bodily member, organ, or mental faculty; or (iv) requiring medical intervention such as surgery, hospitalization, or physical rehabilitation." A hip fracture that goes to the OR meets that definition.

Section 1150B runs alongside 483.12: any covered individual (owner, operator, employee, manager, agent, or contractor) with reasonable suspicion of a crime against a resident must report to the State Survey Agency and at least one local law enforcement entity, within 2 hours if there is serious bodily injury and otherwise within 24 hours. Civil money penalties reach $200,000, or $300,000 if the failure exacerbates the harm or results in harm to another individual.

What New York Adds

Appendix PP says states "may not eliminate the obligation" to report the federal categories, "nor can the State establish longer time frames." States can add, and New York does.

Section 2 of the manual organizes reportable incidents under these headings: Abuse (Physical, Sexual, Verbal, Mental); Mistreatment; Neglect; Misappropriation of Property; Quality of Care: Medication Error/Drug Diversion; Injury of Unknown Origin; Burns; Attempted Suicide or Death or Injury Related to Suicide, Restraints, Equipment or Death Related to Fall; Accidents/Choking; Residents in a Non-Resident Area; Administration of Life Saving Care; and Elopement (outside the facility).

Several of those are reportable regardless of how the federal abuse or neglect analysis comes out. The manual states that "Restraints are considered abuse," reportable with or without injury. Side-rail entrapment is reportable regardless of outcome. Any burn is reportable. "All suicides and suicide attempts must be reported." A resident found in a non-resident or hazardous area is reportable "regardless of the presence of actual injury." Life-saving care that was not provided when required, provided against a DNR, or started and then stopped is reportable. Choking that involves an incorrect consistency or feeding technique by staff, or a failure to reassess a resident who is repeatedly coughing, is reportable.

On medication: an error "with harm" is reportable, as is a deliberate decision not to administer, a pattern of omission, or falsification of records. Missing controlled substances that are not a documentation error and carry potential for a negative outcome are reportable, with a separate report to the Bureau of Narcotic Enforcement on form DOH-2094 within 1 business day.

Section 1 of the manual lists a different class of event, reported immediately by telephone to the regional office, or after hours to the Department's MOCC line at (917) 909-2676: malfunction or misuse of equipment with adverse effects; a physical plant issue or loss of service, defined as "Unexpected service loss lasting or expected to last at least four (4) hours" (or a planned loss of the same length) affecting telephone, electricity, heat, air conditioning, water, kitchen sanitation, or a failed or absent backup; smoke or fire "in any area of the building"; and evacuation or relocation.

The statute underneath the manual is Public Health Law 2803-d. Subdivision 3 says reports "shall be made immediately by telephone" and "in writing within forty-eight hours to the department." Subdivision 4 gives good-faith reporters "immunity from any liability, civil or criminal." The mandated reporter list in subdivision 1 covers operators and employees, administrators, physicians, nurses, therapists, social workers, and others. 10 NYCRR 415.4(b)(2) points back to the same statute for reports to the Department, and it names "injuries of unknown source" explicitly.

Misappropriation has its own police threshold. Under 10 NYCRR 415.26(j)(2)(i), the investigation must begin "not later than 48 hours after receipt," and under (j)(2)(iv) the facility must "notify the appropriate police agency when the results of the investigation indicate there is reasonable cause to believe that a resident's personal property valued at more than two hundred fifty (250) dollars has been misappropriated." Under (j)(2)(vi), a conviction on that referral goes to the Department "within 72 hours of receipt of the notice." The manual adds: "If a crime is suspected, it must be reported to local law enforcement."

The Justice Center has no role here; Social Services Law 488 does not list Article 28 residential health care facilities, so abuse reports go to NYSDOH.

The Fall Scenarios the Manual Spells Out

Falls generate more reportability questions than anything else. The manual works through three directly.

First, the resident found with a fractured hip and no witnessed event. Reportable "if the Nursing Home is unable to determine the cause of the fracture, there is a care plan violation and/or abuse, neglect or mistreatment is not ruled out." Read that as three independent triggers: an unexplained fracture, a care plan not followed, or abuse, neglect, or mistreatment not ruled out. Any one is enough.

Second, the lift transfer performed without the required device that results in a fracture: "Yes, this is reportable." The care plan specified a device, staff did not use it, and the resident was injured. Intent does not enter the analysis.

Third, the injury or pain that shows up after the fall: "Yes, this is reportable, even if the injury or pain was not evident at the time of the fall." Delayed presentation does not reset the analysis.

The general rule: a fall is reportable in New York when the cause cannot be determined, a care plan was violated, abuse or neglect is not ruled out, or the resident dies. Death related to a fall has its own Section 2 category.

On the federal side, remember that the Appendix PP F609 list of what facilities are "required to report" includes "Unobserved/unexplained injury requiring transfer to a hospital for examination and/or treatment" and "Unobserved/Unexplained fractures, sprains or dislocations." An unwitnessed fall with an injury serious enough to send out is on the federal list before you reach the New York analysis. Prevention is a separate tag; see accidents and supervision under F689.

What Is Not Reportable

The manual is equally specific about what does not trigger a report, which is useful for training the charge nurses who make the first call.

A door alarm sounds and staff retrieve the resident. The manual's answer: "No, this is not reportable. If the resident was able to exit the building undetected and staff was unaware, this is reportable." The distinction is detection. Elopement is reportable when the resident exits undetected, fails to return from a pass or outing, elopes from an outside appointment, or is at risk and missing after a search of the building.

An accidental wheelchair bump between residents with no aggression is "incidental touching or contact and is not reportable." Likewise, "Sexual relations between consenting adults (who are capable of consent) are not reportable." A resident grabbing at staff: "No, this is not reportable."

A ring that is missing before anyone has searched for it: "No, at this point, this is not reportable." Search first. What the search finds drives the report, and the 48-hour investigation start under 415.26(j) governs the timing.

Finally, the manual contains no hospital or emergency department transfer trigger. A transfer to the ED is not, by itself, reportable in New York. It becomes reportable through the underlying cause (an unexplained injury, a care plan violation, a medication error with harm), not through the ambulance.

The Clock Question That Decides the Determination

The 2-hour and 24-hour windows are quoted in the manual verbatim from the federal rule: "Immediately, but not later than 2 hours after the allegation is made, if the events that cause the allegation involve abuse or result in serious bodily injury." and "Not later than 24 hours if the events that cause the allegation do not involve abuse and do not result in serious bodily injury." The manual also says "The term 'immediately' depends on the individual circumstance." That is not permission to wait; the outer limit is not the target.

The clock starts when the allegation is made or the suspicion is formed, not when the administrator becomes aware. Appendix PP says the facility "should not make an initial determination whether the allegation is credible before reporting." If a CNA tells a charge nurse at 10:15 p.m. that another aide was rough with a resident, the 2-hour window opened at 10:15 p.m., not when the DON read the text at 7 a.m. When a surveyor reconstructs the timeline, the hours between that first statement to a staff member and the report to the Department are the hours that count.

Appendix PP also says: "Reporting requirements under this regulation are based on real (clock) time, not business hours." Friday at 6 p.m. is not Monday at 8 a.m.

The 5-day follow-up has a wording discrepancy inside the manual itself. One sentence says the Investigation Summary Report is "due 5 working days from the date that the incident was submitted"; another says no later than five business days after the incident. The follow-up form, DAL NH 22-20, and 42 CFR 483.12(c)(4) all count from the incident. If you report the day of the incident, the readings converge. If you report late, they diverge. Count from the incident. A surveyor citing under the federal rule will.

Documenting the Decision Not to Report

Every incident that reaches the reportability question and comes out "no" needs a written decision. A surveyor reviewing the incident log will ask why an event was not reported, and "we discussed it" is not an answer. The memo is also evidence of a functioning abuse prevention program: the facility identified the event, applied the criteria, and reached a conclusion.

Appendix PP sets the expectation directly: "Even if the injury is not one that requires a report, the facility should adequately assess and monitor the resident, notify the physician/resident representative as appropriate, and document the injury and investigation as a part of the resident's medical record."

The memo does not need to be long: when the event was identified and by whom, a factual description, the federal analysis (witnessed, explainable by the resident, suspicious under the three-part test, serious bodily injury), the New York analysis against the Section 2 categories, the care plan review, assessment and physician notification, interviews, and who decided and when. If new information changes the answer, a report supersedes the memo, and the clock runs from the new information.

Under the CMS risk-based survey memo, an abuse citation at any level off a complaint investigation, arriving while a facility is on the qualifying list, removes it from risk-based survey eligibility at the scheduling stage, so a reporting failure can cost you a shorter survey as well as a deficiency.

Bringing It Together

The federal rule is the floor: abuse, neglect, exploitation, mistreatment, injury of unknown source, and misappropriation, within 2 or 24 clock hours of the allegation, with results in 5 working days from the incident. New York adds categories reportable on their own terms (restraints, burns, suicide attempts, entrapment, non-resident areas, life-saving care, staff-caused choking, medication errors with harm, drug diversion), a telephone track for operational emergencies, and PHL 2803-d's immediate telephone and 48-hour written requirement.

For falls, apply the manual's test: unexplained cause, care plan violation, abuse or neglect not ruled out, or death. For everything else, check the Section 2 categories before the federal ones; the New York answer is often "yes" when the federal answer is "it depends."

Report on time when the answer is yes. Write the memo when the answer is no.

Paul Richards, RN, MSHI

Founder, EasyPOC

Paul Richards is a registered nurse and health informatics professional with years of experience in skilled nursing facility compliance and quality improvement. He built EasyPOC to solve the compliance documentation challenges he witnessed firsthand every day.